2019-2020 La Salle Children's Ministry Registration

Please fill out this form and click submit.
Please note that one form is required for each child.

Child Information

Child's Name

Address

Gender

Please select one option.

Female Male

Date of Birth (MM/DD/YYYY)

Grade

Please select one option.

Toddler (Age 2&3) Preschool/Kindergarten Grade 1 & 2 Grade 3 & 4 Grade 5 & 6

Allergies we need to be aware of

Medical Conditions or Medication we need to be aware of

Parent/Guardian Information

Best Phone Number to Reach You

Alternate Ph#

Parent/Legal Guardian Email

This address will receive a confirmation email

Permission to Correspond

Please select one option.

Yes No

Your child will be cared for as if s/he were our child. It is understood that those persons in charge will exercise caution to prevent injury. By signing this form you agree that neither those in charge nor the church shall be held responsible in case of accident. Additionally, photographs or video footage may be publicly taken of the minor by ministry leaders for ministry purposes only (which may include posting to social media and/or the ministry website).

Parent/Guardian Consent

I consent to photographs or video footage of my child (consent may be withdrawn upon written notice)

Please select one option.

Yes No

I hereby consent to my child participating in La Salle Children's Ministry hosted by La Salle Community Fellowship.
*By entering your full name, birthdate and by clicking "Submit" (below) you are electronically giving consent for your child to participate in this program.

Parent/Legal Guardian Name

Parent/Guardian Birthdate (to confirm identity) MM/DD/YYYY

Description

Please fill out this form and click submit.
Please note that one form is required for each child.

2019-2020 La Salle Children's Ministry Registration

Description

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